Although I’m a certified athletic trainer, it’s rare that I seek any type of physical treatment for myself. There are many reasons, but mostly I just feel bad about asking fellow clinicians to treat me when I know they’ve already been treating patients all day. Recently though, something wonderful happened. I asked Mark Shires, MS, ATC, PES, to treat my left shoulder and neck because of tension headaches I’ve been experiencing (for months at this point)… and he said yes!

(Image/Courtesy CNX Anatomy & Physiology Textbook)

Mark is not only a longtime friend to both myself and HawkGrips, but also works as an athletic trainer for Major League Baseball’s Baltimore Orioles. So naturally, we decided to document the treatment for your viewing pleasure (see Instagram video clip at the end of this article).

Headache History

I am a classic case of “do as I say, not as I do.” I have poor upper-body posture, protracted and anteriorly tilted scapula, and a forward head. I sleep on my left side — surprise! — the same side where I get tension headaches.

My headaches have become steadily more frequent over the past few months, from occurring a couple times each month to pretty much every day. They range from just an ache at the base of my skull to a full-fledged, classic “ram’s-horn pattern” headache around the entire left side of my head. I typically self-treat with stretching and ibuprofen when it becomes unbearable.

Treatment

Mark has treated me before for tension headaches and I know that his distinctive cocktail of passive release, active therapy, and instrument assisted soft tissue mobilization (IASTM) with HawkGrips has worked wonders for me. Just one day after my treatment, I already applied the same therapy he performed on me to two of my coworkers!

It is becoming a normal occurrence for patients to complain of tension headaches, so clinicians who treat almost all walks of life should know how to successfully treat this condition. Here are a couple important points to keep in mind:

The upper trapezius muscle is usually very hypertonic. Many people carry stress in their shoulders, have poor body mechanics, and/or sleep on their side with their shoulder “jacked up” and the upper trap and levator scapulae muscles in a shortened position for eight hours every night.

When treated with IASTM, this area tends to develop petechiae very quickly due to the extreme hypertonicity. Please remember that your treatment should end once petechiae occur to avoid bruising your patient in a sensitive area (read: try not to give your patients hickies!). Fair-skinned patients, thin-skinned patients, and patients on blood thinners will all develop petechiae a lot faster than other individuals!

Now you may be thinking, “If I should stop treatment when my patient has petechiae, how can I treat a fair-skinned patient with tension headaches for longer than the 15 seconds it takes for petechiae to develop?”

The answer? Don’t treat her upper trap with IASTM the first time (or couple times) that you see her! Start with some passive-release techniques or dry needling to release the trigger points and encourage that muscle to relax a little, before you figuratively try to chip away a boulder with a dull chisel!

Instead, use IASTM on the oft-forgotten muscles — scalenes, sternocleidomastoid (SCM), and longus colli, to name a few. Framing out the anterior border of the upper trap and gently teasing through the scalenes will bring immense relief to most of the patients who walk through your door. This is exactly what Mark did for me.

Passive Release

First, he utilised passive release on my upper trap to address the “golf balls” he found there, before picking up the HawkGrips instruments and going to work on my scalenes and distal attachment of the SCM. As Mark treated me, my left temporalis and left eyelid were both twitching, which was mildly unnerving (pun intended!).

Right away, he was able to identify two or three “hotspots,” which I confirmed with him. Mark had me move through a slow, steady range of motion, cueing me to “take my chin towards my right knee, then look up towards a spot on the ceiling slightly over my right shoulder.”

At the same time, he encouraged me to very gently shrug up my left shoulder toward my left ear, then depress it to end range. Boy, were those “hotspots” tender at the end range! I could feel him decrease pressure when the tissue was on a stretch, in order to limit my reaction to pain and discomfort by muscle guarding.

Now What?

Overall, the initial treatment lasted about seven minutes and elicited only mild redness, which went away in less than 15 minutes. He was then able to treat me again lightly about 45 minutes later, as you can see in the accompanying Instagram video. Mark prescribed stretching exercises and scapular stabilisation strengthening, as well as a new pillow and sleeping position. A full day later, I still hadn’t experienced any tension headaches. I was mildly tender to palpation, but nothing that affected my activities of daily living and with no hickey-resembling spots to concern my husband. Overall, it was a wonderful treatment and I’m extremely grateful to Mark for taking the time to fix me!